osce pediatrics cme (dr.d.y.patil medical college)

OSCE MADE EASY

CME, 19/8/2012

Dr. Ashwin BoradeConsultant, Sant Dnyaneshwar Medical Education & Research

Centre,PuneConsultant, Inamdar Multispecialty Hospital ,Pune

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Objective structured clinical examination (OSCE)

30 stations (4-5 rest stations) = 150 marks

Five observed stations (50 marks = 1/3rd of OSCE)

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OSCE is an skill assessment of your entire post graduation.

It attempts to assess candidates in all aspects.

It’s an opportunity for student to make up marks.

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• FOLLOWING ARE TYPES OF STATIONS (Based on memory of candidates)

• 1.COUNSELLING• 2.NATIONAL PROGRAMME• 3.CLINICAL QUESTION• 4.PERIPHERAL SMEAR• 5.WASTE MANAGEMENT• 6.IMMUNIZATION PROGRAMME• 7.NUTRITION• 8.PICTURE• 9.ABG• 10.DRUG• 11.STATISTICS• 12.BIBILOGRAPHY

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13.CLINICAL METHOD14.PSM15.INSTRUMENT 16.ECG17.X-RAY18.HISTORY TAKING19. GENETIC20.CT/USG21.PEDIGREE CHART INTERPRETATION22.NEONATAL RESUCITATION/PALS23.POISONING  24.PROCEDURE

Format of questions

• Q / A• Clinical scenarios• Match the following • Fill in the blanks• Photographs, charts, slides

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REST STATIONOBSERVED STATION

OBSERVED STATION

OBSERVED STATION

OBSERVED STATION

OBSERVED STATION

REST STATION

REST STATION

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Blank OSCE SheetsQuestion

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• The OSCE Questions & Answers are prepared by the faculty for the benefit of Post graduate students.

• These Questions and answers are made for the students to understand the pattern of OSCE and not meant to completely cover the subject of Pediatrics.

• Answer are checked from standard textbook in case of doubt plz email

• ashwinborade@yahoo.com1304/10/2023 CME,Pune

Imaging

• X ray (CVS, RS,GIT, CNS, NUT)• CT scan • MRI scan• USG ( neonatal) • Nuclear scan

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What you should Know

• View , preparation, dye used

• Normal structure seen in image

• Abnormality/ problem

• About disease and Treatment of disease 1504/10/2023 CME,Pune

• Describe the X ray findings .• What is the diagnosis?• What is the treatment of choice ?• Write 4 life threatening complications of Kawasaki disease.• Write 4 side effects pertaining to CVS of Digitalis .04/10/2023 16CME,Pune

• X ray chest PA view with air trapped s/o Pneumopericrdium

• Pneumopericrdium• O2 and monitoring if severe distress prompt

evacuation.• MI, Coranry aneurusm, Thrombosis, DIC• Atrial, ventricular extrasystole, heart

block,AV block, VT,VF

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• 1. Identify and describe the findings.

• 2.What is probable diagnosis ?

• 3. What is the treatment?

• 4. What is Indian contribution in treatment of this condition

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Answers

• CT scan showing Ventricular dilation • Hydrocephalus• Medical Acteazolamide, furosemide and

surgical VP shunt• Chhabra Shunt /Upadhyaya VP shunt

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• Interpret the MRI (1)

• Interpret the EEG (1)

• What is the most probable diagnosis (1)

• Name the drug of choice (1)

• What is the definition of Eosinophilic Meningitis (1)04/10/2023 22CME,Pune

Answer • Cortical damage seen in Bilateral temporal

lobes• PLEDS Periodic lateralizing Epileptiform

Discharges• HSV Encephalitis• Acyclovir• 10 or more eosinophils/mm3of CSF

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• A premature baby was ventilated and on 2 ed day had convulsions. His investigation done which is shown here

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• Identify and describe investigation • Spot the diagnosis with grade• What are preventive measures?• What is the commonest neurological sequel?• What is the commonest Opthlmoligical

sequel?

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Answers• Cranial USG showing cystic PVL• Grade 2 PVL• Early interventions , maintain normal

cerebral perfusion• Spastic diparesis• Strabismus, nystagmus, ROP

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• Peripheral Smears and slides and clinical photographs

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• What you should Know

• Peripheral smear and B.M Picture, • Stain, method , Normal cells, abnormal cells,

Parasite• Hematology and Oncology • Inheritance, clinical feature, Prognostic factor• Treatment, recent advance

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Clinical Photo :-

• Syndrome, disorder • Instrument, PFT, • Dermatology, Neurocutenous mark, Rash, • Clinical sign

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• Identify this slide (1)

• Name 2 drugs which can cause this state (2)

• Name 2 non nutritional causes of this state (2)

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Answers

• Macrocytic anemia

• Phenytoin / Sulfa group / Zidovudine / Phenobarbital

• Hypohyroidism / orotic acid uria / Lesch Nyhan syndrome / Down syndrome / Marrow failure

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What is the organism ?

What is the commonest presentation ?

What is the drug of choice by FDA ?What is incubation period?

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• Giardia Lamblia • Mostly asymptomatic (but rarely Sudden

onset explosive watery diarrhea with distension of abdomen)

• Tinidazole ,Nizonide• 1-2 weeks

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An anxious mother of a day 5 neonate has brought her baby with history of following rash since birth. What is this condition 1What is the etiology 1How complications you can encounter1What is the management 1

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• Klippel Trenaunay weber syndrome • cute nous cavernous vascular malformation• Cellulites, Thrombophelitits, Heart failure,

Gangrne • corrective surgery and supportive care

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• ECGS

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What you should Know

• Normal ECG / Various waves and duration calculation• ECG in CHD/ RHD/ electrolyte disorder

• Atrial Flutter ,Wide Complex Tachycardia • Atrial Fibrillation ,Pericariditis- ,Sinus Tachycardia • Wolff Parkinson White ,Heart Block ,Electrolyte

abnormalities

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• What does this EKG strip show (1)

• Name 3 EKG findings that helped you in diagnosis (1)

• Name 2 emergency pharmacological treatment options of a SVT. (1)

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Answer

• Wolff-Parkinson-White [WPW] syndrome)

• short P-R interval, delta wave, and wide QRS

• adenosine / phenylephrine / edrophonium / Verapamil

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• STATION 1:

• 1. Identify the ECG

• 2.  Name drugs causing this

• 3. Name Inherited conditions a/w this

• 4.What is the treatment?

• 5.what is common clinical presentation?

:

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• Long Qt• Amidarone, cispride, Haloperidol• Jervell and Lange-Nielsen syndrome

Romano-Ward syndrome• B blokers• Syncopal episodes by exercise , fright

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EEG

Normal waves , pattern

Typical EEG pattern in some disorders

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• 8 mts old female child with delayed development milestones flexor spasm EEG done.

• Describe characteristic EEG findings• What is diagnosis?• What is T/t?• Which type having the good prognosis?

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• Hppsarrythmia• Infartile spasms• ACTH and glucocorticoids• Cryptogenic infantile spasms

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• Clinical case scenarios

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• What you should Know• Case • Infection , CVS,RS, CNS,Endo.• HBsAg +ve, Chicken Pox,HIV, TB• Unimmunized child, Rabies• Infection :- Rash, clinical feature, incubation,

Period drug of choice, isolation complications• Endocrinology• BMI, Target height, short stature, DKA,

insulin dosage, Tanner staging4804/10/2023 CME,Pune

• A 10 day old infant male suddenly developed vomiting, lethargy, not feeding well on evaluation his CBC and sepsis work up was negative. His ABG showed PH 7.38 PCO2 -40

• Plasma NH3 525 umol/L• What is Probable diagnosis?• Enlist drugs used to treat it?• What is commonest form of this disorder?• In this patient what form will be more severe?• What lab parameters are decreased in neonatal

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• Urea cycle defect• Sodium benzoate, Argenine, cetrulline• Carniline, Lactulose• Carbomoyl Phosphatan synthase deficiency• OTC deficiency• Platelet, WBC count

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Drugs and Vaccine

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• What you should Know• Drugs• Classification, dosage, route, uses, side effect,

precaution. Eg.Adrenaline, sodabicarb, Ampo B, IVIG, Surfactant

• Drug of choice,IV fluid constituents, ORS

• Vaccine• UIP, IAP schedule, Newer vaccine• Vaccine dose, schedule side effects indications

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Caffeine Citrate • Which group this drug belong ? (1)

• What is mech of action (1)

• What are indications? (1)

• What is dosages ? (1)

• What are side effects? (1)5304/10/2023 CME,Pune

Answers

• Methylxantine• Resp. centre stimulation, Antagonism of

adenosine, Incr. Diaphragm contractility• Apnea of prematurity• Lading dose 20 mg/Kg IV followed by 5-12

mg/kg• Cardiac arrthymia, tachycardia, Irritability

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• What is dose of Leviractam and Lamotrigine?

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• Leviractam 20 mg/kg/day• Lamotrigine 2 MG/kg/24hrs → 5-10

mg/kg/day

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Chicken pox vaccine • What is the dose ?• What strain is used ?• Post exposure prophylaxis how vaccine can

be given?• What are indications for varicella

immunoglobin in neonate

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Answers

• 0.5 ml S. C• Oka strain• Within 72 hrs ( 3-5 days)• If mother develops varicella 5 days before

to 2 daysafter delivery

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• Electrolyte/ ABG’s / Ventilators

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• What you should Know

• Case study• Interpretation of ABG, calculation of PaO2,

CaCo2• Formula for AaDo2, OI• Ventilator setting/modes/change as per ABG

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A 4 yrs old male child with fever and AGE admitted in PICU with cold extremities and respiratory distress . His ABG done showing pH -7.27 , PaCo2- 33 mmHg, PaO2- 84 mmHg, HCO3- 17mMol/Land base excess- 7 mMol/L

• What is ABG diagnosis• What is line of treatment?• What is formula to calculate AaDO2• What is formula to calculate OI• How u calculate anion gap

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Answer• Metabolic acidosis

• IV fluid resuscitation

• AaDO2 = PA02-PaO2

• OI= MAPX FiO2/ Postductal PO2 X 100

• Na- Cl – Hco3

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• PSM / Statistics / Biomedical / Biblography

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• What you should Know• Health Programme – ICDS, CSSM, Mid Day Meal,RNTCP• Biomedical Waste – Infectious waste,Non infectious waste• Medical Stastics• Def. Mean, mode, meclian, 1st Quartile, 3rd Quartile incidence

Prevalance, Specifically• Case Control, cohort study• TP, TN, RR, odd ratio

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• What is RNTCP?• When was RNTCP was started ?• As per RNTCP aim is to achieve cure rate

of• What is defaulter ?• What is treatment failure?

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Answer• Revised Natioanl Tuberculosis control program• 1992• 85%• Patient who return sputum smear + ve after having left t/t

for 2 months• Patient who was smaer +ve and on t/t remain sputum smear

+ ve again at 5 months or later during t/t.

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Dispose the following waste• Wound dressing material• Needles• Plastic wraper• Indwelling Umbilical catheters• Discarded food

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• Wound dressing material – Yellow bag• Needles –Blue puncture proof container• Plastic wraper- Black Bags• Indwelling Umbilical catheters– Red bags• Discarded food- Black Bags

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Write following journal article in Vancouver style

Article :Cardiogenic Shock With Hypereosinophilic Syndrome

Authors :Vinitha Prasad, L Rajam and Ashwin Borade

Journal : Indian Pediatrics

Year :2009

Volume 46

Page 801-8036904/10/2023 CME,Pune

Author's surname Initials, Author's surname Initials. Title of article. Title of Journal. [abbreviated]

Year of publication Month date;Volume Number(Issue number):page numbers.

• Prasad V, Rajam L , Borade A.Cardiogenic Shock With Hypereosinophilic Syndrome. Indian Pediatr. 2009;46: 801-3.

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• During a study at hospital the PEFR of 100 adolescences boys follow a normal distribution with a mean of 280 lit/min, standard deviation 30 lit/min and standard error of 2 lit/min

• What will be the range in which 95% of the boys PEFR will lie in the sample?

• What will be the range in which mean PEFR of the population will lie from which the sample was taken?

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Range in which 95% of girls PEFR in the sample will lie:

mean +/- 2SD = 280 +/-2(30)=220-340

Range in which mean PEFR Value will lie: mean +/- 2SE( Standard error)-

95% Confidence interval = 280+/- 2(2)= 276-284

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• Determine the sample size to find out the Vitamin A

requirement in the under five children of Pune district . From

the existing literature the mean daily requirement of the same

was documented as 930 I.U with a SD of 90 I.U. Consider the

precision as 9.

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Quantitative data

N = 4SD2/L2

4 x 90 x 90 /9 x9 = 400

• Qualitative data N = 4pq/L2

• P = positive factor /prevalence/proportion• Q = 100 – p• L = allowable error or precision or variability• 4 = 1.962(Alpha error) 2

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Station

• What is name of curve ? (1/2)

• What are uses ? (1)

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Answer

• A scatter plot chart• It displays series as a set of points specified

by x and y coordinates. A scatter plot is useful for showing nonlinear relationships between variables. It requires at least one category and two series (representing the x and y coordinates).

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Instruments

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Station Identify the instrument. (1/2)What are indications? (1/2)What are contraindications ?(1/2)What is size equipment to be used for child of 7 Kg? (1/2)

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Answer

• Larygneal mask airway• Elective surgical procedure where face

mask are used or endotracheal intubation is not necessary.

• Known or unexplained difficult airways, Profound unconscious patient, patient who resist LMA

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Identify instrument?

What it measure ?

What are uses?

How u calculate PEFR using hight in OPD ?

At which variability of PEF we garde as mild intermittent asthma?

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Answers

• Peak flow meter• It measure Peak expiratory flow rate• Used to assess severity of asthma and

response• Diagnosis of asthma and monitoring• PEFR= ( Ht – 100 ) X 5 + 100• < 20 %

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• Emergencies and Poisoning

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•

• 1. Identify the ECG

• 2.What is the treatment if hemodynamic compromise?

• Which cardiac condition it is assosiated ?

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• VT• Defibrillation • Cardiomyopathy, ALCAPA,

Intramyocardial tumors, Following corrective surgery for TGA, VSD

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A 4 yrs old child brought in ER at 10 AM with 12 kg and 45 % burn while playing at 8 AM , as a attending Pediatrician

• Calculate his fluid requirement in 48 hr ( As Per Parkland Formula)

• His 24 hr correction will be complete by which time?

• What is the desired S. albumin level• In this patient how much 0.5 % albumin u

will infuse

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Answers

• 1st 24 hrs RL 4 ml X 12 ( wt) X 45 ( % of burn ) • ½ in first 8 hrs and ½ in over 16 hrs (2160 ml)

• 2 ed 24 hrs RL with 5 % D ( ½ of 1 st day fluid)• Next day 8 AM• 2 gm/dL• 30-50% burn 0.3 ml of 0.5 % alb/ Kg/ % of burn over 24 hr

(0.3 X12X 45 = 162 ml)

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Match the following antidotes

• Paracetamol Atropine/PAM• Dhatura BAL• Cyanide myl Nitrite• Mercury Physostigmine• OP N- Acetylcysteine • INH Naloxone hydrochloride• Opiods Pyridoxine

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Answers

• Paracetamol N- Acetylcysteine• Dhatura Physostigmine• Cyanide Amyl Nitrite• Mercury BAL• OP Atropine/PAM• INH Pyridoxine• Opiods Naloxone hydrochloride

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Nutrition / Growth / Development

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Arrange following food items in descending order of calories content

• 1 cup Tea• 1 TSF Sugar• 1 glass milk ( 200 ml)• 1 cup Cooked Rice• 1 egg• 1 TSF Ghee/ Butter • 1 TSF cooked dal

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• 1 cup Cooked Rice 175• 1 glass milk ( 200 ml) 120• 1 egg 80• 1 cup Tea 60• 1 TSF Ghee/ Butter 36• 1 TSF Sugar 20• 1 TSF cooked dal 10

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Station Write average age of attainment in months

for following milestone

• Brings hands together in midline (1/2)• Builds tower of 6 cubes (1/2)• Follows one step command without gesture

(1/2)• Speaks 10-15 words (1/2)• Stares at own hand (1/2)• Pretend play with doll (1/2)04/10/2023 92CME,Pune

• Answer

• Brings hands together in midline -3• Builds tower of 6 cubes-22• Follows one step command without gesture-

10• Speaks 10-15 words-18• Stares at own hand-4• Pretend play with doll-17

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Write down the age at which following reflex appears

• Palmer grasp• Rooting reflex• Moro reflex• Tonic neck reflex• Parachute reflex

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Answers

• Palmer grasp 28 Wks• Rooting reflex 32 Wks• Moro reflex 28-32 Wks• Tonic neck reflex 35 Wks• Parachute reflex 7-8 months

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Genetics

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• What you should Know

• Pedigree, Mechanism of inheritance• Example, Symbols, clinical photo• Associated anomalies• Karyotype, features, T/t

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1.Identify patter of inheritance 2.What is the characteristic feature of this inheritance3.Give 2 examples4.In this disorder which organs are most affected

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1. A mitochondrial inheritance pedigree

2 All the children of an affected female but none of the children of an affected male will inherit the disease.

3.MERRFand MELAS

4. Organ with greater energy requirement like brain, muscle and heart, liver

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A neonate in LR with characteristic crying

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• What is the diagnosis• What is the defect• What is commonest presentation ?• What cardiac lesion can be seen with this?• What facial feature can be seen with this?

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Answers

• Cri Du Chat syndrome• Micro deletion of short arm of chr, 5• Cat like cry ( hypotonic, SS, microcephaly)• VSD, ASD,PDA• Microcephaly, moon like face,

hypertelorisum, epicantal fold, wide flat nasal bridge

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• Video / audio / Figures

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• Video of procedure , NRP• Audio heart sound• Figures- diagrammatic presentation of

murmur, type of respiration, ophthalmic findings

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During intubation which is the correct position

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What is the score is called ?What are uses ?

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• Silverman anderson score• Asses respiratory distress in newborn

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A 4 day old newborn delivered by LSCS with resiratory distress admitted in nicu brought with icterus, on evaluation s. bilirubin was 16.5. what ur

plan of tretment

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Start PT

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Plot hight weight of the child and interpretage 4 yrs , Ht-100 cm, Wt-15

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Best of Luck

Thank You

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